Smoking and HIV.

Twenty years ago, people who found out they had the Human Immunodeficiency Virus (HIV) felt as though they had been given a death sentence. At that time we did not have medicines that had been shown to be very effective in slowing the progression of the virus and preventing the onsite of diseases associated with AIDS. A large proportion of people who are HIV+ are also smokers, partly because some of the lifestyle behaviors that put one at risk of HIV also are risk factors for smoking (e.g. people who exhibit high risk behaviors such as having unprotected sex with multiple partners, or using intravenous drugs, also are much more likely to smoke). Unfortunately, back in the days before effective treatments for HIV/AIDS, HIV+ smokers didn’t see much point in quitting smoking because they perceived it as very likely that they would die from AIDS before suffering from smoking-caused diseases like lung cancer.

However, in the twentieth century we now know that with proper use of antiretroviral therapies, a 25 year-old who is HIV+ will likely live at least another 35 years, and probably longer with medical advances during that time. This is good news for people who are HIV+. Unfortunately one thing that hasn’t changed in line with effective HIV treatment is the perception of how important it is to quit smoking if you have HIV. While the smoking prevalence among U.S. adults recently dipped below 20%, studies among people who are HIV+ find a smoking prevalence of 45-74%. Often providers, recognizing that having HIV can lead to many stresses and challenges, feel reluctant to tackle the patient’s tobacco dependence. But there are many reasons why it is, if anything, MORE important to quit smoking if you are HIV+. Here are a few:

-Some of the antiretroviral medicines are metabolized more quickly if you smoke

-There is some evidence that antiretroviral medicines may increase cardiovascular risks, as does smoking, so it is important to avoid a double risk

- HIV+ smokers are three times more likely to contract certain serious AIDS-defining illnesses, such as bacterial pneumonia.

There has not been a very large amount of research on smoking cessation specifically in people with HIV, but the studies published so far tend to find results that are highly consistent with the studies in the general population of smokers. So there is every reason to expect that treatments proven effective for smoking cessation (e.g. nicotine replacement therapy and counseling) will also help HIV+ smokers to quit. Some specialist services are now being developed. One weblink was recently sent to me by AIDS specialist and colleague Dr Jonathan Shutter, and is worth checking out at: www.positivelysmokefree.com

I’d be interested in hearing comments on that website and also any experiences of quitting smoking after a positive HIV test.

Labels: AIDS, cessation, cigarette smoking, HIV, jonathan foulds, tobacco

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